This is a blog by a former CEO of a large Boston hospital to share thoughts about negotiation theory and practice, leadership training and mentoring, and teaching.

Wednesday, August 02, 2006

Running a hospital

Hi,

The other day, I was reading a NY Times article that menitoned that only 1 CEO of a Fortune 500 company had a blog. I don't run a Fortune 500 company, but I do run Beth Israel Deaconess Medical Center, a large academic medical center in Boston. I thought it would be fun to share thoughts with people about my experience here and their experiences in the hospital world. This is my first blogging experience, so please excuse if I mess things up . . .

A few rules: I cannot comment on individual and legally confidential patient care issues in this forum -- although I can refer patients of our hospital to the appropriate people if they have problems or complaints. I also cannot comment on individual and legally confidential personnel matters of our employees -- although I can refer people to the appropriate folks in the hospital to help them.

So, that's it. Feel free to open this up with questions about what it is like to run a 600-bed hospital; or to offer your thoughts about the state of medical care in general; or to comment about how wonderful (!) our hospital was during a recent visit; or what it is like to work at our hospital or whereever you work.

My first comment is this: I am new to health care, and I have never worked in a place where people are so consistently caring and devoted to alleviating human suffering caused by disease. It is, in many ways, a beautiful place to work. But many of the forces facing hospitals, doctors, nurses, and others make it really hard to do the job well.

22 comments:

> I have never worked in a place where people > are so consistently caring and devoted > to alleviating human suffering caused > by disease.

From my very first visits to "the B.I.D." (Paul's hospital), the people were conspicuously alert, interested, and empowered. Not once did I encounter someone with an attitude of "There's nothing I can do about it," which I'd seen elsewhere in so many medical offices.

I'm a little disturbed to hear that the forces Paul mentioned are making it hard (especially "really hard") to do the job well, even at a place like that. So I hope this blog will open up some productive dialog.

DearDr.Levy,My friend, Anil Madan,forwarded your good words and I certainly agree. We used to provide the property insurnace for BI/Deaconess and I enjoyed my interactions with Dick Lee, Ed Kushmreck and others. Earlier this year my wife died from lung cancer after a real struggle; we learned from your example and did the best job we could. Yours, Wallace Savory

A good point of departure for all those on this part of the blog is to read the Jan 2003 Paul Levy profile in the Boston Globe, about a year after he began as CEO. There were some immediate decisions he had to make in the wake of the BI-Deaconess merger, and the profile discusses them well. Going forward, the decisions in a way become more difficult, with pressures from the payers and the always-hovering presence of government.

Health Care for All, a very fine organization that has been at the forefront of issues here in Massachusetts, has been kind enough to mention this blog on theirs, http://blog.hcfama.org/. Check it out.

I appreciate the opportunity of getting a glimpse of a hospital CEO’s perspective! My personal experiences with BID have always been VERY positive. I’m sure you are aware of the exceptional service your nursing staff provide.

Thanks. It can definitely feel like another world when you are a patient in an emergency room in a big city hospital. The range of cases that show up in any given day is huge, from bee stings to cardiac arrests. People with relatively minor problems may find themselves waiting a long time. Also, if the hospital is full, people may have to wait in the emergency department for hours, until a patient is discharged from a floor upstairs.

For folks who live in Boston's western suburbs, our hospital in Needham has a very fine emergency room, with the same doctors you will find downtown, and usually with a much shorter wait.

Paul, Welcome to the health care profession. I just became aware of your blog, and I applaud your initiative. I sympathize with your comment that "many of the forces facing hospitals, doctors, nurses, and others make it really hard to do the job well." As an internist who has interacted with many hospitals over the years, I'm a true believer in the importance of communication in organized medicine.

In that vein, I would like to let your readers know of an upcoming continuing education program at the Massachusetts Medical Society (MMS) that will focus on the importance of communication in the increasingly complex dynamic of physician-hospital relationships. On Saturday, November 18, 2006, a CME program entitled "Physician-Hospital Relationships: Where Do You Stand?" will take place at the MMS Headquarters in Waltham, MA.

The program will be comprised of two sections. In the morning, nationally-known and highly-respected Elizabeth (Libby) Snelson, Esq., will help participants to gain a greater understanding of medical staff bylaws and the peer-review process. In the afternoon, a panel presentation will take place addressing "The Challenge of Communication." Topics will include "Impact of Hospitalists," "The Absence of Community Physicians," "The Disruptive Physician," "The Legal Impact of Questioning Authority" and more. The panel will be moderated by morning presenter, Libby Snelson, and will include James Butterick, M.D., chief medical officer for Cape Cod Hospital, Ellen Epstein Cohen, Esq., of Adler, Cohen, Harvey, Wakeman and Geukguezian, Joseph M. Heyman, M.D., member of the Board of Trustees of the AMA, and Alan C. Woodward, M.D., president of Emerson Hospital Emergency Physicians, Inc.

I hope you agree that this program would be of tremendous value to any physician. Along with learning how to participate in the assessment and development of hospital and medical staff bylaws, the "ins-and-outs" of the peer-review process, and improved communication, physicians will also earn 6.0 AMA PRA Category 1 Credits.

More information on this program can be found via this link: http://www.massmed.org/AM/Template.cfm?Section=Continuing_Education&template=/Conference/ConferenceDescription.cfm&ConferenceID=101.

Again, thank you for opening up this valuable portal for medical professionals to learn and find motivation. Best of luck in your new position, and I look forward to future "blogging."

As a Boston-area resident who has given birth to three kids at the Beth Israel Deaconess, I've long been impressed by the caring and skill of the hospital's staff.

As a marketer working with medical device and diagnostics companies, I'm astounded to see the CEO of a major teaching hospital with a public blog. So much of what one can do or say in the health care space today is limited by business liability concerns. To see the warmth and honesty of your comments is really refreshing. Thank you.

Thanks very much. Borrowing from Garrison Keillor, I offer a guarantee to all of our prospective parents that all babies born at BIDMC are above average! Please call me in several years if their SAT scores fail to confirm that . . .

Oops, should I have run that comment by my lawyers?!

Seriously, there are many liability concerns in running any large organization, but there are also many things we can talk about that are simply matters of opinion -- and if people in the field do not talk about them openly, how can we expect the general public, legislators and other policy makers to be informed?

welcome to the blogosphere! It's great to see yet another hospital CEO joining us! Nick Jacobs (the first hospital CEO to start a blog) is a core blogger over at our blog, hospital impact. Nick's a great guy (also previously a non-hospital person) - you guys should trade notes!

Very enjoyable reading Paul. As a Wisconsin-based Planning/Marketing hospital guy, I appreciate your take(s) on advertising and the misrepresentation therein.

Some of your posts made me thing about about 10 years ago when I did a short stint at a health insurance company. During my interview process, they kept talking about how they were part of the health provider team. I finally had to stop someone during the interview and ask who on the team that I'd be working with actually had hospital work experience. Answer - none.

I look forward to reading about the stories about the staff and patients that demonstrate the intangibles that take place at a hospital.

Paul,Just saw you on Emily Rooney show.Congratulations on the Blackberry!

Why don't all hospitals offer the same discounts to all insurers to create a level playing field for competition? Are you worried that BC/BS is leveraging its power to become the only real player in MA healthcare?

I greatly enjoy your blog and read it often. By the way, BIDMC uses RASMAS, the Risk And Safety Management Alert System, that helps hospitals deal with recalled medical products more efficiently. Are you familiar with it?